Objective : To assess and compare the clinical effectiveness of combination treatments of DPP4 inhibitors+metformin and SGLT2 inhibitors+metformin in routine clinical practice.
Methods : The present study is a retrospective analysis of T2DM patient’s records who were initiated with either DPP4 inhibitor+metformin (TG1) or SGLT2 inhibitor+metformin (TG2). Registered patients visiting for consultation to Apollo Sugar Clinic were included in the analysis. Patients consent was taken at the time of registration. Demographics and baseline data were obtained from electronic medical records database of Apollo Sugar Clinics. Data were analyzed using descriptive statistics and significance was set at p ≤0.05
Total 3790 patient’s prescriptions were analyzed, 94.7% were on TG1 and 5.3% were on TG2. Mean age was 54.9 years, 62.4% males and 37.6% females. Mean BMI was 25.5kg/m2, HbA1c was 8.6%, fasting and post-prandial blood glucose (BG) were 174 mg/dL and 259 mg/dL, respectively. At treatment initiation there was significant difference in mean HbA1c between TG1 (8.6%) and TG2 (8.1%) (p <0.001); at follow up the HbA1c reduced to 8.2% in TG1 and 7.8% in TG2 (p <0.002). However, the mean change in HBA1c between the groups was not significant. A significant difference in fasting (TG1 174kg/m2; TG2 158 kg/m2, p <0.03) and post-prandial (TG1 262kg/m2; TG2 213 kg/m2) BG at baseline, and at follow up fasting (TG1 156kg/m2; TG2 141 kg/m2, p <0.03) and post-prandial (TG1 228kg/m2; TG2 197kg/m2, p <0.003), but the mean change was not significant. At follow up 33% of TG2 patients achieved HbA1c <7% compared to 27% of TG1.
Discussion : Though the mean change between the groups was not significant, 65% of patients on SGLT2i achieved HbA1c target of <8% compared to DPP4i (55%).
Conclusion : Current analysis was in large data set obtained from real clinical practice. The results show that patients receiving either of the treatment had improvement in glycemic outcomes at follow up.
Krishna Seshadri– Consultant Endocrinologist, Apollo Sugar Clinics, India
Dwarakanath CS– Senior Endocrinologist, Apollo Sugar Clinic, Apollo Hospital, India
Venkataraman S– Senior Diabetologist, Apollo Sugar Clinic, Apollo Hospital, Chennai, India
Manikandan RM– Endocrinologist, Apollo Sugar Clinic, Apollo Hospital, Madhurai
Boochandran TS– Senior Endocrinologist, Apollo Sugar Clinic, Apollo Hospital, Chennai
Jayaprakashsai Jana– Senior Diabetologist, Apollo Sugar Clinic, Hyderabad
Jayashree Gopal– Senior Endocrinologist, Apollo Sugar Clinic, Apollo Hospital, Chennai
Mahesh Chavan– Senior Endocrinologist, Apollo Sugar Clinic, Apollo Hospital, Mumbai
Vamsi Kolukula– Head Clinical Excellence, Apollo Sugar Clinics Limited
Shashank Joshi– Senior Endocrinologist, Lilavati and Bhatia Hospital, Mumbai, Maharashtra, India
Apollo Sugar Clinics, India
Dr. Krishna Seshadri is a Internal Medicine and Endocrinologist in Adyar, Chennai and has an experience of 20 years in these fields. Dr. Krishna Seshadri practices at Fortis Malar Hospital in Adyar, Chennai,Apollo Speciality Hospital in Vanagaram, Chennai and Apollo Sugar Clinic in Vanagaram, Chennai. He completed MBBS from Madras Medical College, Chennai in 1989 and MD - Internal Medicine from Rush University, Illinosis, USA in 1998.
He is a member of American College of Physicians,American Endocrine Society,Indian Medical Association (IMA),Association of Physicians of India and Indian Endocrine Society. Some of the services provided by the doctor are: Circumcision, Peyronies Disease and Hypogonadism
Apollo Sugar Clinic, Apollo Hospital, India
Dr. Dwarakanath C.S. is a Endocrinologist in Basavanagudi, Bangalore and has an experience of 31 years in this field. Dr. Dwarakanath C.S. practices at Surya Endocrine Diabetes Centre in Basavanagudi, Bangalore, Surya Endocrine Diabetes Centre in Nagarbhavi, Bangalore and Apollo Sugar Clinic in Bannerghatta Road, Bangalore. Completed MBBS from JJMMC, Davanagere in 1984,MD - Medicine from Mysore Medical College, Mysore in 1988 and DM - Endocrinology from All India Institutes of Medical Sciences, AIIMS, New Delhi in 1996. Member of Karnataka Medical Council and Indian Medical Association (IMA).
Apollo Sugar Clinic, Apollo Hospital, Chennai, India
Dr. Venkatraman S is a General Physician and Diabetologist in Greams Road, Chennai and has an experience of 34 years in these fields. Dr. Venkatraman S practices at Apollo Sugar Clinic in Greams Road, Chennai. He completed MBBS from Madras University, Chenai, India in 1978 and MD - General Medicine from Madras University, Chenai, India in 1984.
He is a member of Tamilnadu Medical Council. Some of the services provided by the doctor are: Insulin Free Treatment,Head and Neck Infection Treatment,Filaria Treatment,Vaccination/ Immunization and Diabetes Management
Apollo Sugar Clinic, Apollo Hospital, Madhurai
Dr. R M Manikandan is a Endocrinologist and General Physician in Madurai East, Madurai and has an experience of 14 years in these fields. Dr. R M Manikandan practices at Apollo Hospital in Madurai East, Madurai and Apollo Sugar Clinic in KK Nagar, Madurai. He completed MBBS from Annamalai Universtiy in 2003,MRCP (UK) from Federation of Royal college of Physician of the United Kingdom in 2012 and MRCP - General Medicine from Royal Colleges Of Physicians,london, Uk in 2008.
Apollo Sugar Clinic, Apollo Hospital, Chennai
Dr. T.S.Boochandran is a Doctor in Greams Road, Chennai and has an experience of 26 years in this field. Dr. T.S.Boochandran practices at Apollo Hospital in Greams Road, Chennai. He completed MBBS from University Of Madras in 1987 and MRCP from Royal College Of Physicians Of United Kingdom in 2001
Apollo Sugar Clinic, Hyderabad
MBBS, MD (Physician), Robert Turner Diabetes Research Training, WHO/IDF/EASD Cambridge Diabetes Training, FCD (Diabetology), Certificate Course in Evidence Based Diabetes Management (CCEBDM), Post Graduate Diploma in Diabetology (PGDD).
Dr. Jayaprakashsai practices at Apollo Sugar Clinics in Banjara Hills, Hyderabad. He is well known in the medical community for the service he has rendered for spreading awareness on diabetes. He was given an appreciation award by the Rotary Club of Hyderabad (Central) in 2009. In 2014, he received the Diabetes Awareness Initiative Award, Bangalore from USV India Ltd.
Apollo Sugar Clinic, Apollo Hospital, Chennai
Dr. Jayashree Gopal is a Doctor in Anna Nagar, Chennai and has an experience of 15 years in this field. Dr. Jayashree Gopal practices at Apollo Sugar Clinic in Hospital in Greams Road, Chennai. She completed MBBS from the University Of Madras in 1991 and D.N.B (Diplomate in Endocrinology, Diabetes, Metabolism) from Diplomate Of The American Board Of Internal Medicine in 2012
Apollo Sugar Clinic, Apollo Hospital, Mumbai
Dr. Mahesh Chavan is a Fulltime Consultant Endocrinologist at Apollo Sugar and Apollo Hospitals, Belapur, Navi Mumbai. After completing his DNB training, he has also worked in prestigious KEM Hospital, Dept of Endocrinology. After working in MGM Hospital, Vashi for last 5 years, he has joined Apollo Hospitals since September 2016. Apart from beIng well trained in diabetes Dr Chavan, has special interest in thyroid disorders, metabolic bone disease, endocrine tumours
Head Clinical Excellence
Apollo Sugar Clinics Limited
Dr Vamsi Krishna Kolukula, as a Physician, Researcher, Advisor, medical graduate with profound knowledge in pharmacology, medicine, molecular biology research and health care administration. Clinical and research experience in educational and pharmaceutical industries.
Lilavati and Bhatia Hospital
Mumbai, Maharashtra, India
Prof Shashank R. Joshi MD, DM, FACP, FACE, FRCP
Endocrinologist, Lilavati & Bhatia Hospital
Consultant and Advisor, Apollo Sugar Clinics
President, Indian Academy of Diabetes, Past President, Endocrine Society of India
Past President, Research Society for Study of Diabetes in India(RSSDI)
Past President, All India Association for Advancement of Research in Obesity Past President, Association of Physicians of India, Emeritus Editor, JAPI
Indian Chapter Chair, AACE
He was honored by the Government of India, in 2014, by bestowing on him the Padma Shri, the fourth highest civilian award, for his services to the field of medicine. He is also a recipient of the International Clinician Award, received at the 21st American Association of Clinical Endocrinologists (AACE) Annual Scientific and Clinical Congress, Philadelphia. This is an annual award given to practicing endocrinologists, outside the US